Alicia: Vascular Coding, and the title of
this one was Not Cardio – Vascular Coding. So, we always say “cardiovascular coding,”
but Caren was saying, let’s look at the vascular aspect and a lot of people don’t realize there’s
really a difference there. And this was an intense overview of many types of vascular
fields and, again, it was awesome! I really enjoyed this. Let’s see… I took one of her, just a little
highlight. This stuff, when you go to these conferences its intense and just great information.
The objectives that are covered in this session, she went over: Understanding anatomy for vascular
coding. Review of the rules for vascular procedures. Review of ICD-10 future coding. And, understanding
documentation on vascular notes. Honestly, it felt like she went over a lot more than
that. One example she talked about bypass. Most
of us think of cardio bypass around the heart, but there are other places in the body that
have bypass procedure stuff. So, as we scroll down, she actually pulled out the coding for
renal. So, she said, these are the things you need to do first: Where is the blockage
at? So, anatomically, where’s the blockage? Is it a native or in an existing graft? That’s
very important. And what vessel are you connecting to? So, those three things you have to be
able to express in your coding. And let me tell you guys, I almost, there
were some awesome pictures out there and I almost put up one open and then doing the
surgery, and I thought it’s kind of late at night, you guys might have had supper late,
tummy’s upset, and I didn’t want you barfing. I would have loved it, but I was being nice
to you. Let’s look here – this is just a little bit
of anatomy. Look where you see that major artery going down the abdominal aorta artery,
and then see where there as it goes to the kidney, that renal artery, that has started
the disease process in that artery. So, they have to go in and do a bypass. As we scroll down, she has a real good picture.
You can’t take the information, they give you all the notes and stuff, but that stuff
is they don’t let you grab a copy and paste that. But I found this picture of a grafting,
and look it says two different types — end to side and end to end — just to give you
an idea that what they’re doing is they’re taking vessels and they’re moving them and
stitching them in to another artery so that it feeds the good blood, the oxygenated blood
where it needs to go. Go do a Google image search on vascular grafting and you’ll get
a good education — maybe you won’t, it’s kind of gory some of it. What is included? This is what you’re going
to have in your coding, you’re going to have the harvesting (the procurement per CPT language).
That’s what they call the harvesting — is the procurement of the saphenous vein. The
completion of the angiography. The vein valve lysis, physician may describe using a valvulotome
— I’m sure there’s a different way to say that. And per the CPT “Primary vascular procedure
listing include established both inflow and outflow by whatever process necessary.” So,
those are the things that’s included on these procedures. But what’s not included? This is also very
important: Diagnostic arteriogram, if there is not a recent prior clinically adequate
study or patient has suffered recent change in vascular status. Harvest of upper extremity
vein, which is 35500 and it’s an add-on code. Harvest of popliteal vein, one segment, 35572.
Harvest and construction of autogenous composite graft — and autogenous means like autograft,
it means it’s coming from your own body, and then those codes. Adju — say that word. Laureen: Adjuvant. Alicia: Adjuvant — OK, I don’t think I would
have said it that way — procedures. Again, I’m not going to be quoting these codes for
you. But be careful to read, she said, the parentheticals associated with the codes.
These give important information about how to properly use these add-on codes. So, you
really got to pay attention to the detail when you’re doing this. Educate your physician. If you’re in a situation
that is an exception to the rules — and I’m sure there are lots of them — be sure that
the documentation supports your code and that it is modified correctly! Very important.
So, that is just one little segment of the stuff that she went over. It was pretty amazing,
real juicy, good information. Laureen: Hey, Alicia, can you explain native
versus graft? Alicia: OK. So, when they’re saying “native”
that means that is the vessel that you have in your body already. It’s your “native,”
to you. A graft is something outside that’s being replaced and not natural. It wasn’t
made that way, they’re either bringing in a piece of something else or they’re taking
an artery or a vein from someplace else and they’re grafting it in. That’s the difference.
When you’re doing CAD, you always have to, they do CABGs and stuff, that’s all the grafting
process is and you’ll notice that the codes will say “native” or “graft” and it changes
the code from 414.01 to 414.00 whether its native or graft. That’s what — Laureen: Someone is saying they want me to
go back up to what’s included — there you go. Alicia: OK. Laureen: And it’s valvulotome. Alicia: Valvulotome, that sounds good. Laureen: Valvulotome. A “tome” is a cutting
instrument. Alicia: You know what, there is a website
out there. If you don’t like the way Laureen and I say things, there is supposedly this
site out there and you can Google it, that gives you the pronunciation and they have
a British accent — the person that reads it. So, that sounds kind of funny. Laureen: Someone is asking, human or non-human?
I think they’re taking about the graft material. Alicia: This one was human. If it says “auto”
that’s human, “xeno” is from another species, and let’s see what’s the other one, there’s
“auto” — Laureen: Allo, allo. Alicia: “Allo” which is from the same specie
but a different person. So, “auto” is like autograft. Laureen: Right. Alicia: Like yours, autograft. The “xeno”
is another species, and then — is it allograft? Yeah, auto and allo. Allo is that it would
be like taking a kidney from another family relative and putting it into you. Whereas,
a pig valve replacement that they do in the heart, that would be a xenograft, because
it’s from another species. Laureen: Xenograft can also be those manmade
grafts, too. Alicia: Yeah, because it’s not from — Laureen: A human. Alicia: Yeah, not Homo sapien. Laureen: [laughs] Leslie says Alicia is so
funny – yes she is. Alicia: [laughs] Laureen: I got to share this story about trying
to find her bright yellow canary Camaro. Alicia: Oh my [laughs]. Laureen: In the parking lot at the Gaylord
Opryland, which is this huge sprawling place and — Alicia: Laureen was freezing. Laureen: That was so cold. Alicia: She had like flip-flops on her because
her feet were sore. Laureen: Oh my goodness, and — Alicia: I kept saying, “I see something yellow,
it looks familiar.” Laureen: Because she was moving from sharing
a room with one lady and then moving in with me so we could prepare this for you guys.
And she went to move the car closer. By the time we found the car and we got in it and
drove around we literally moved the car probably 20 feet. I could have killed her. Alicia: That was not even 20 feet [laughs] Laureen: So, I wasn’t thinking that she was
so funny that night but — Alicia: Yeah, she was really cold and tired.